Provider Demographics
NPI:1265976286
Name:GRIMME, TONYA MARIE (FNP-BC)
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:MARIE
Last Name:GRIMME
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3270 INTERTECH DR
Mailing Address - Street 2:
Mailing Address - City:ANGOLA
Mailing Address - State:IN
Mailing Address - Zip Code:46703-7325
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:603-052-6552
Practice Address - Street 1:3270 INTERTECH DR
Practice Address - Street 2:
Practice Address - City:ANGOLA
Practice Address - State:IN
Practice Address - Zip Code:46703-7325
Practice Address - Country:US
Practice Address - Phone:260-305-2622
Practice Address - Fax:260-305-2655
Is Sole Proprietor?:No
Enumeration Date:2016-12-09
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71015831A363LF0000X
FL9325364363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily